Federal review reveals room for improvement in NH EMS system

A review concluded that New Hampshire’s EMS system is in good shape, but its dependence on volunteers and an under-resourced trauma system threaten its sustainability

By Todd Feathers
The New Hampshire Union Leader

CONCORD, N.H. — New Hampshire’s EMS system is in good shape overall, but its dependence on volunteers and an under-resourced trauma system threaten its long-term sustainability, according to a new federal review.

The Granite State’s network of fire departments, ambulance companies, hospitals, EMTs and dispatchers sets a national standard for communication and excels in other key areas, according to the National Highway Traffic Safety Administration report.

But nearly half of New Hampshire’s hospitals are not designated trauma centers, sometimes complicating decisions for paramedics transporting seriously injured patients. And many important roles — from administrative boards that set statewide policy to front-line personnel — are filled by volunteers, who are becoming increasingly difficult to find.

“The system needs to adapt and evolve as we progress as a state,” said Justin Romanello, chief of the state’s Bureau of Emergency Medical Services.

NHTSA conducted its assessment at the request of state officials, who also commissioned a review of New Hampshire’s trauma system by the American College of Surgeons in 2016. Both reports put forward a series of recommendations for the trauma system — which includes preventative education, pre-hospital care, hospital care, and rehabilitation — that Romanello said will serve as a blueprint for the Bureau of Emergency Medical Services going forward.

Trauma patients — those involved in life-threatening car crashes, for example — account for only about 20 percent of the 250,000 calls New Hampshire EMS responds to annually, but they represent many of the most visible and complicated cases.

All 26 acute care hospitals in the state are prepared to stabilize trauma patients, and 14 have gone through the state’s voluntary inspection process and been designated trauma centers, meaning they can treat more severe trauma cases rather than transferring stabilized patients to a more advanced hospital.

Of those 14, the ACS has granted its even more stringent certification to Dartmouth-Hitchcock Medical Center as a Level 1 trauma center and Portsmouth Regional Hospital as a Level 2 trauma center, indicating that they are capable of handling the most difficult cases.

Romanello and others involved in the state’s EMS system would like to see 100 percent of the state’s hospitals obtain trauma center designation in order to shore up large geographic gaps, particularly in the northern and western parts of the state.

“It was reported that EMS routinely transports trauma patients to facilities that do not have a trauma designation, even when transport to a designated trauma center warrants bypassing the closest facility,” the NHTSA reviewers wrote in their report.

Several hospital officials contacted for this story declined to comment on the record because the issue of trauma center designation is one mired in political battles for funding and competition between hospitals over a relatively small pool of trauma patients.

Hospitals must pay for an ACS review and for some smaller institutions it can be prohibitively expensive to meet the standards — such as a round-the-clock neurosurgical team — of a Level 1 or Level 2 hospital.

“We just don’t have as many appropriate facilities in the area … A lot of hospitals in our area will stabilize (the patient) and then get them transported to an appropriate hospital” which can delay care and increase medical costs, said Bruce Harvey, operations manager for Lakes Region EMS. “For hospitals to maintain a level of staffing (necessary for trauma center designation), it costs a considerable amount of money.”

Several New Hampshire hospitals are in the process of obtaining higher ACS certification.

As with many industries in the Granite State, a workforce shortage is putting pressure on the state’s EMS system.

“The most rural parts of the state remain dependent on volunteers and are facing the challenge of replacing this ever-decreasing resource,” according to the NHTSA report.

There are currently 5,317 licensed EMS personnel in the state, including emergency medical responders, emergency medical technicians, and paramedics.

Portsmouth fire Chief Steven Achilles has been in the fire service since 1985 and was on the state’s Emergency Medical and Trauma Services Coordinating Board for nearly a decade.

In recent years, he’s observed a decline in people entering the public safety field.

“The workforce is harder to maintain, whether it be volunteer, part-time, on-call or full-time services,” Achilles said. “When the economy is good it seems like it’s harder to fill the workforce.”

But Granite Staters should be happy with the results of the recent NHTSA report, including the problems it highlighted, he said, because it indicates that the state is proactively looking to improve.

“I think it’s refreshing that the state actually sought a reassessment,” Achilles said. “A lot of dedicated people at a lot of levels are trying to make sure New Hampshire is safe, and I think we can be proud of that.”

Copyright 2018 The New Hampshire Union Leader

McClatchy-Tribune News Service

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